Let’s talk about a topic that is often overlooked in our medical end of life care: bowel movements. Why bring up a subject that is difficult to discuss? Because there are major misconceptions about bowel movements in people who can’t be fixed and people who are taking medicines for pain, narcotics and/or non-narcotics. Everybody has bowel movements, everyone needs to have them, yet in our prudishness we tend to not talk about them. I think we are embarrassed to bring up the subject but we need to. So, here I go.
We often think that when a person is not eating very much they will then not have much to eliminate. Wrong. Whether we eat or not our body still produces waste and we will still need to eliminate that waste.
Being active helps us poop therefore the less active we are, and people approaching the end of their life through disease or old age gradually have less and less energy hence do less and sleep more, the more prone to constipation we will be. Constipation becomes a problem as activity decreases. Laxatives become necessary.
Narcotic and non-narcotic pain medicines slow bodily functions and constipation becomes a big issue. Anyone taking medication for pain needs to be taking a laxative. Pain medicine and laxatives go together, always. Don’t wait until the person is impacted with three or four days of backed up stool and in great discomfort before considering a laxative.
So, most people with a life threatening illness need to be assessed for a laxative regime. Of course there are exceptions, the particular disease and the person’s bowel history can affect and determine bowel activity, but everyone needs to be assessed. Ninety nine percent of people on pain medicine will need to also be on a laxative.
What kind of laxative? Ask the doctor who prescribed the pain medicine what is recommended. Generally, the stronger the pain medicine the stronger the laxative.
Something More... about Let's Talk Poop...
Caring for someone at end of life is challenging and when pain is part of the dying process, the challenge intensifies. That's why I wrote Pain At End of Life: What You Need To Know About End of Life Comfort and Pain Management. It addresses, in fifth grade, non-medical terminology:
- pain as it relates to the dying process
- fear of overdosing and addiction
- standardized dosages
- around the clock administration
- laxatives
- uses of morphine
- sedation as it relates to dying
- supplemental therapies
65 comments
Hi Sonia, About your question “Could these be the signs of her last days?" I don’t know your lady’s medical history so I can’t say whether she has entered the dying process but from what you have written it does not appear that she has begun “labor" (weeks to days) although the changes you mentioned could signal the beginning of “she may not be here next year at this time”. I just don’t have enough information to be more specific. I do suggest you talk with her family physician to get her bowels more regulated and tell him/her of the changes you are seeing. Thanks for reaching out to me. Blessings to you in the work you are doing. Barbara
Hi Barbara, I care for someone who has COPD & kidney disease both are stage 4. She has been withdrawing herself from going out and shopping. She doesn’t want to shower , she is extremely moody and she is either constipated or has diarrhea. We never have a good day where she goes regularly. Could these be signs of her last days? She also has been trying to reach out to her daughter whom she hasn’t spoken to in 15 years.
Hi Priscilla, it does sound like your father has entered the dying process. Withdrawing, sleeping a lot, not eating very much, losing weight, wetting or stooling himself, his age, all tell me death is approaching. When becomes the question. Since I don’t know all the medical particulars I can’t give a length of time. Actually no one can. We die in our own way and our own time but we can get an idea of how long based on the progression of the above signs I mentioned. The restlessness could be an indication of weeks but again I don’t know all the details of your father’s disease. You said your father was on Hospice. Ask your nurse your questions. Hospice is there to guide and support you, to answer your questions, to make this experience easier for you. If I can be of any help use my personal email barbara@bkbooks.com. My blessings are with you and your family during this challenging time. Barbara
I just had a thought—if you haven’t read my booklet Gone From My Sight it will be helpful in guiding you during this time. Ask your hospice if they have it or get it from my website.
Hi. My father is 85 and he is very ill. I know for sure he is diabetic, and has copd. He is in hospice, and keeps losing weight. He is down to 83 pounds. Is having bowel movement on himself a sign that the end of life is near? He barely eats, sleeps alot, and is very restless. He also has a fatty liver, and smokes alot.
Hi Sarah, I do not know what is happening with your mother’s bowel movements. Have you checked with her physician? Could be drug side effects (check the list of side effects on all the drugs she is taking), food issues or something more serious. Blessings! Barbara
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